Complete Story

01/08/2018

OOS Meets With Anthem on Modifier 25 Cut

On December 20th, representatives from the Ohio Ophthalmological Society, American Academy of Ophthalmology, Ohio State Medical Association and several other state specialty societies met with Anthem in Columbus to raise significant concern with some of its proposed policy change, most specifically its announcement to reduce payments by 50% for E&M services billed with CPT modifier 25 when reported with a minor surgical procedure code or a preventive/wellness exam. The changed was initially scheduled to become effective in Ohio on January 1.

Subsequent to the meeting, Anthem announced it was delaying implementation of this policy until March 1 and reducing the level of the reduction to 25% instead of 50%, as originally planned. While encouraged by these two changes the OOS, AAO and OSMA will continue to the dialogue with Anthem to make additional changes to the policy. Should you have any questions regarding the change or our advocacy efforts on this issue, please contact us at oos@ohioeye.org.